LATTICE DEGENERATION

For patients who have peripheral retinal changes associated with lattice degeneration, the lattice inevitably undergoes further deterioration. However, in most patients, this deterioration is not vision threatening. The deterioration that can be seen in the peripheral retina is generally not visible to the patient. However, your eye care providers will be able to notice and monitor these progressive changes. These changes may include the development of tractional changes in the areas of lattice, extension of the lattice i.e. increase in size, sclerosis of vessels, and areas of atrophic hole formations. In the majority of these situations, no further intervention is warranted and simple screening coupled with symptom management by patients who look for progressive symptoms such as flashing lights, a black curtain extending across their vision, or new onsets of floaters can trigger further investigations and possible management.

Conversely, lattice degeneration can lead to tears in the peripheral retina and retinal detachment, both of which can cause vision loss. Treatment of lattice degeneration involves inspecting its progression over the long term and using laser treatments to either prevent vision loss or fix it. Cryo therapy, while a less common method of treatment, is also used to treat patients with lattice degeneration.

A retina with lattice degeneration (above) has darker pigmentation than a healthy one.

WHAT IS THE DISEASE?

Lattice degeneration or the thinning of the peripheral retina, can lead to a number of ocular conditions. Its basic symptoms include seeing flashes of light and a sudden increase in the number of floaters or black spidery curtains in one’s vision.

In terms of retinal damage, lattice degeneration may cause the retina to stretch and become displaced along with the development of hardened blood vessels (sclerosis) and macular holes. All of these effects can contribute to substantial vision loss spread into the central retina. Retinal tearing is also encouraged by posterior vitreous detachment (PVD), whereupon the detaching vitreous body pulls on the thinning retinal membrane and causes it to tear. The accumulation of sufficient retinal tears leads to retinal detachments in either tiny sections or the whole retina. Unlike tears in the peripheral retina, retinal detachment can cause severe vision loss.

Lattice degeneration can be detected early and prevented using laser treatment long before it deteriorates a patient’s vision. By allowing a retinal specialist to monitor the retina over the long term, it is possible to detect whether it is necessary to take laser or surgical measures to prevent or treat lattice degeneration before it seriously deteriorates a patient’s vision.

TREATMENTS

Laser is the most common preventative and direct treatment for lattice degeneration. For patients who have previously experienced a retinal detachment, have a family history of retinal detachments, are myopic, and/or are travelling to places where they would have no access to ocular treatment, laser treatment can effectively decrease their risk of future retinal detachment. This is done by applying the laser to retinal surfaces prone to tearing and using the laser to reinforce the attachment between the retina and the back of the eye in parts where it has become weak. Such preventative measures greatly decrease the likelihood that a macular hole or detachment will develop and thus protect the patient’s long-term vision.

Moreover, laser treatment directly treats the effects of lattice degeneration by sealing tears in the peripheral retina closed, keeping the retinal tears from spreading from the peripheral to the central retina, thus preventing the distortion of a patient’s vision. Possible complications due to laser treatment include the development of blind spots (scotomas), impaired night vision, and decreased central and peripheral vision. To treat cases of retinal detachment by lattice degeneration, however, requires a vitrectomy surgery, pneumatic retinopexy, or older technology surgery, such as sclera buckling.

There are certain risk factors which can make laser treatment unsuitable for a patient, including myopia and the presence of sub-retinal fluid in the area of the macular holes. If laser treatment is deemed too dangerous for the patient, they may instead be offered cryo therapy.